Prospects of contemporary diagnostics of acute kidney injury in patients with acute coronary syndrome
V.P. Zajceva, M.L. Nanchikeeva, L.V. Kozlovskaja, V.V. Fomin, N.M. Bulanov, Ju.V. Krasotkina
1 SBEI HPE "Ivanovo State Medical University" of the MH of the RF, Institute of Postgraduate Education; 2 SBEI of HPE "First MSMU n.a. I.M. Sechenov" of the MH of the RF, Faculty of Preventive Medicine, Department of Internal Medicine, Occupational Diseases and Pulmonology; 3 CJSC Generium
Objective: To assess the clinical significance of urinary excretion of kidney damage markers - albumin, kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with acute coronary syndrome (ACS), including complicated by acute renal injury (ARI).
Materials and methods: A total of 70 patients with acute coronary syndrome (mean age=64 years, 45 males/25 females) were enrolled in the study. The control group was composed of 10 healthy subjects comparable to the study group patients by sex and age. The diagnosis was verified according to clinical guidelines. A complete clinical, laboratory and instrumental examination was performed, including testing of urinary excretion of biomarkers of glomerular (albuminuria) and tubular (KIM-1, NGAL) damage.
Results: ARI according to the KDIGO definition was found in the majority of the study group patients with ACS (89%). Development of ACI in the study group patients did not depend on age, sex and left ventricular systolic function. It was more strongly correlated with the development of acute myocardial infarction ‒ 47 of 50 (94%) patients, than with unstable angina ‒ 15 of 20 (75%) patients. Both the mean levels of the marker of structural renal damage (albumin, KIM-1 and NGAL) in the urine, and the frequency of their increased urinary excretion, were significantly higher in ACS patients with AKI than in patients with preserved renal function.
Conclusion: The combination of functional parameters (creatinine dynamics) and markers of structural renal damage (urinary excretion of albumin, KIM-1 and NGAL) is necessary to improve timely diagnosis of AKI and predict the prognosis of kidney damage in patients with acute coronary syndrome.
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About the Autors
Information about the authors:
Zajceva V.P. – Doctoral Student of Department of Internal Medicine and Primary Care of Institute of Postgraduate Education of SBEI HPE IvSMU of the MH of the RF
Nanchikeeva M.L. – Professor of Department of Internal Medicine and Primary Care of Institute of Postgraduate Education of SBEI HPE IvSMU of the MH of the RF, Ph.D.
Kozlovskaja L.V. – Professor of Department of Internal Medicine, Occupational Diseases and Pulmonology of the Faculty of Preventive Medicine of SBEI of HPE "First MSMU n.a. I.M. Sechenov" of the MH of the RF, Ph.D.
Fomin V.V. – Professor of Department of Internal Medicine, Occupational Diseases and Pulmonology of the Faculty of Preventive Medicine, Pro-Rector of Clinical Practice of SBEI of HPE "First MSMU n.a. I.M. Sechenov" of the MH of the RF, Ph.D.
Bulanov N.M. – Doctoral Student of Department of Internal Medicine, Occupational Diseases and Pulmonology of the Faculty of Preventive Medicine of SBEI of HPE "First MSMU n.a. I.M. Sechenov" of the MH of the RF
Krasotkina Ju.V. – Head of Department of Biochemical Production of CJSC Generium